Risk of needle tract seeding of breast cancer: cytological results derived from core wash material

Abstract

Needle track seeding has been recognized as a possible, albeit rare, complication of breast core needle biopsy. The purpose of this study was to assess the risk of needle tract seeding of breast cancer from cytological results derived from core needle wash material. The study included biopsies of 207 breast cancers performed using ultrasonographically guided 18-gauge core needles. Each core needle without exposed sample notch was washed in saline solution immediately after removing the needles. Cytology derived from core wash material was performed by saline solution lavage of the fragments using a cytocentrifuge. The cytological diagnoses were divided into five categories: benign, atypical/indeterminate, suspicious/probably malignant, malignant and unsatisfactory. Atypical/indeterminate, suspicious/probably malignant and malignant categories were considered to represent positive cases of needle track seeding of breast cancer, whereas benign and unsatisfactory categories were counted as negative cases. Cytological diagnoses of the 207 lesions were as follows: 26 lesions (12%) were benign, 18 lesions (9%) were atypical/indeterminate, 37 lesions (18%) were suspicious/probably malignant, 79 lesions (38%) were malignant, and 47 lesions (23%) were unsatisfactory. The incidence of positive cases of cytology derived from core wash material was 65% (134/207). The 25% frequency of positive cases of invasive lobular carcinoma was significantly lower than the frequencies of DCIS (74%) and invasive ductal carcinoma (69%) (P = 0.001 and P < 0.01). The frequency of positive cases in the multiple passes group was 75%, which was slightly, although not significantly, higher than the 66% frequency in the single pass group (P = 0.3). In conclusion, the incidence of positive cases of cytology derived from ultrasonographically guided breast core needles' wash material was 65%. The clinical significance is debatable; however, there may be a theoretical risk of local recurrence if the tract is not excised or radiotherapy not given.

Modified core wash cytology procedure for the immediate diagnosis of core needle biopsies of breast lesions

“…In benign tumors the cohesiveness of the tissue and cells is much higher than in malignant lesions. 7,11 In our study, the histological benign diagnosis on touch imprint or core wash cytology was noticed as benign or atypia favoring benign. Our study showed slight differences between core wash and touch imprint in figures.…”

“…8 Others use the technique to investigate the possibility of needle tract seeding. 11 Still, touch imprint is mostly used for providing a preliminary diagnosis. The sensitivity ranged from 74%-95%, whereas specificity ranged from 97%-100%.…”

The International Academy of Cytology Yokohama System for Reporting Breast Fine-Needle Aspiration Biopsy Cytopathology

“…CNB is more invasive, time consuming, has a higher rate of complications, and has a greater cost for both the biopsy equipment and the required histopathological laboratory processing and reporting [16, 21, 22]. There are reports of a risk of track seeding by carcinoma [23], and of a possible worse prognosis after CNB [24]. …”

Cancer Cell Seeding Following Manipulation: An Ancient Concern According to the Traditional Iranian Medicine

“…Several studies suggest that FNA can rarely cause needle track seeding or cutaneous metastasis at Biopsy Site in renal, pancreatic and hepatic (primary or metastatic) cancers [9][10][11]. As well, a few cases of breast cancer with the same complication after CNB have been reported [12,13]. There are also studies implying that procedures like prostate biopsy or surgical removal of the tumor during a colonoscopy (in colorectal cancer) may increase the number of circulating tumor cells (CTCs) in the blood in some cases [14,15].…”